Comparison of Bleeding Risk between Rivaroxaban and Apixaban in Atrial Fibrillation (COBRRA AF)

Lay Abstract: The direct oral anticoagulants (DOACs) apixaban and rivaroxaban have been compared to standard therapy for stroke prevention in atrial fibrillation (SPAF) in randomized controlled trials (RCT) and are both approved by Health Canada. No safety or efficacy data is available from direct head-to-head comparison of these anticoagulants. Increased use of DOACs, limitations of Phase 3 trials, patient concerns, and litigation over bleeding events highlight the need for a comparison trial. The overall aim of this RCT is to compare the safety of 12 months duration of apixaban twice daily to rivaroxaban once daily in patients with non-valvular atrial fibrillation (AF). Patients will be monitored for the primary outcome of major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) events during follow up. This trial will directly inform clinical practice and possibly lead to change in first line therapy.